Individual
DR. LEONARD Y WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
47835
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0143863
—
MA
01
—
B33635
BLUE CROSS
MA
Enumeration date
09/14/2005
Last updated
03/10/2010
Update your record
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